Howard Bolos, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC1719 Issued in FL

Practice address

113 Maryland Ave
Cocoa, FL 32922-7832

Phone

(321) 636-4422

Fax

(321) 632-9254

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1609984665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MARYLAND AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227832",
            "telephone_number": "321-636-4422",
            "fax_number": "321-632-9254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 MARYLAND AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227832",
            "telephone_number": "321-636-4422",
            "fax_number": "321-632-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOS",
        "first_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "FL",
            "license": "OPC 001719",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC1719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078230100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald William Bird, D.D.S.
• Janis G Black, DO
• Nicole Blacks
• Karen Marie Bleuel, MA. CCC-SLP
• Claire C Boland, LMHC
• Alishia Marie Bonasera, M.S., BCBA
• Elijah Bookhart
• Mykenzi Jean Boone
• Matthew Border, LMHC
• Paloma Bornas Contreras

• Optometrist in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.